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Stress, Depression Linked to Raised Stroke Risk in Seniors

THURSDAY, Dec. 13 (HealthDay News) -- Stressed out? A new study suggests that learning to deal effectively with life's challenges may help you reduce your risk of stroke, especially as you age.

Researchers found that people over 65 with the highest levels of psychosocial distress -- including depression, a negative outlook and dissatisfaction with life -- had triple the risk of death from stroke as compared with those who had lower levels of stress.

"Emotions have a significant impact on health, and people know when they're feeling stressed out," said study author Susan Everson-Rose, an associate professor of medicine at the University of Minnesota, in Minneapolis. "It's important that they recognize the physical impact of these psychological factors and practice relaxation techniques proactively."

According to the U.S. Centers for Disease Control and Prevention, stroke is the fourth leading cause of death in the United States and a leading cause of long-term disability.

The researchers were interested in finding risk factors for stroke that people could actually change. Previous studies have linked depression with increased stroke risk, especially in women, but some research focusing just on women has suggested that the risk may extend beyond sadness to include situations in which people develop a negative outlook on life. The authors wanted to test the concept on a broader population with a wider set of psychological issues.

The study, published online Dec. 13 and in the January print issue of the journal Stroke, used data from the 1997-1999 Chicago Health and Aging Project, research that involved interviews in participants' homes on the south side of Chicago. The surveyors asked 4,120 black and white adults aged 65 and older questions about their symptoms of depression, perceived stress, signs of anxiety, anger, feelings of vulnerability and life satisfaction. The researchers used standardized rating scales to identify the levels of stress the participants reported.

Factors such as race, age, gender, level of education attained, stroke risk, history of chronic health conditions and medications to control blood pressure or relieve depression were identified so they would not affect the conclusions drawn from the data. Notably, race and sex did not affect stroke risk, the study authors said.

Researchers identified 151 deaths from stroke and 452 events that led to being hospitalized for a stroke. The deaths were verified by the National Death Index and the hospitalizations were based on Medicare claims from the U.S. Center for Medicare and Medicaid Services.

The study showed that increasing levels of distress are related to increased risk of both fatal and nonfatal stroke in black and white seniors. The researchers also found that stress was associated with increased risk of hemorrhagic stroke, the type caused by a brain artery bleeding, but not by ischemic stroke, which is caused by a blood clot in an artery.

Dr. Ralph Sacco, chairman of neurology at the University of Miami Miller School of Medicine, explained how stress could be related to a stroke specifically caused by bleeding. "Increased blood pressure and abnormalities in blood clotting have previously been shown to be associated with stroke," he said.

Sacco noted that it was especially interesting that the researchers identified what is called a dose response: the most distressed participants experienced more than a twofold increased risk of stroke mortality and a 32 percent increased risk of stroke, compared with those who reported less stress.

"The study adds to the growing evidence that stress is a significant factor in cardiovascular disease and stroke," Sacco said.

The study found a link between greater levels of distress and stroke incidence in seniors. It did not prove cause-and-effect.